Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID)

Abstract

Background Reproductive health services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic. Methods Natsal-COVID Wave 2 surveyed 6,658 adults aged 18-59 between March-April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18-44, described as female at birth. We analysed contraception use and switching, contraceptive service access, and pregnancy plannedness in the year from March 2020. Findings Amongst all participants (n=1,488), 14.3% (12.5%-16.3%) reported switching or stopping contraception due to the pandemic. Of participants at risk of unplanned pregnancy (n=1,169), 54.1% (51.0%-57.1%) reported routinely using effective contraception in the past year. 3.2% (2.0%-5.1%) of those using effective methods pre-pandemic switched to less effective methods, while 3.8% (2.5%-5.9%) stopped. Stopping/switching was more likely amongst participants of younger age, non-white ethnicity, and lower social grade. 29.3% of at-risk participants (26.9%-31.8%) reported trying to access contraceptive services; of whom 16.4% (13.0%-20.4%) reported their needs went unmet. Unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%-11.1%) were scored as 'unplanned'; less planning was associated with younger age, lower social grade and unemployment. Interpretation Although many participants reported accessing contraceptive services during the pandemic, one-in-six of these reported an unmet need. Inequalities in unmet need and risk of unplanned pregnancy - related to age, ethnicity, social disadvantage and mental health - potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.